944 Dual- Versus Single-Antibiotic Loaded Cement for Hip Hemiarthroplasty: A Systematic Review and Meta-Analysis

Abstract

Aim
Hip hemiarthroplasty is a common treatment for hip fractures in the elderly, but surgical site infections (SSIs) remain a significant concern. Antibiotic-loaded cement (ALC) is used to reduce this risk; however, the efficacy of dual antibiotic-loaded cement (DALC) versus single antibiotic-loaded cement (SALC) is debated. This systematic review and meta-analysis compares the efficacy of DALC and SALC in preventing infections in hip hemiarthroplasty.

Method
A comprehensive search was conducted in CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and grey literature sources, adhering to PRISMA guidelines. The inclusion criteria encompassed randomized controlled trials (RCTs) and comparative observational studies evaluating DALC and SALC in hip hemiarthroplasty. The primary outcome was the incidence of deep SSIs, and secondary outcomes included superficial SSIs, mortality, antibiotic use, and complications. Data were synthesized using a random-effects meta-analysis.

Results
Five studies with 28,418 participants were included. DALC significantly reduced the risk of deep SSIs compared to SALC (RR 0.47; 95% CI 0.29–0.76; P=0.002; I²=27%). DALC also lowered the risk of any infection (RR 0.55; 95% CI 0.38–0.79; P=0.001; I²=27%). No significant differences were observed for superficial SSIs, mortality, antibiotic use, or complications.

Conclusions
DALC significantly reduces the risk of deep SSIs and overall infections in hip hemiarthroplasty, demonstrating its potential as a superior option to SALC. However, further large-scale RCTs are required to confirm these findings and evaluate long-term outcomes.